| NPI | 1174515118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX U1430) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME93458) |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: FL ME93458) | |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: MD D88314) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2023-03-20 |