| NPI | 1104840016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: TX M6721) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX M6721) |
| 207W00000X Ophthalmology (Licence: SC 23521) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-02-04 |