| NPI | 1104211283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: GA 91739) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 312393) |
| 207W00000X Ophthalmology (Licence: OH 57027483) | |
| 207W00000X Ophthalmology (Licence: KY TP126) | |
| Enumeration Date | 2015-04-05 |
| Last Update Date | 2023-08-30 |