| NPI | 1205809159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0009X Ophthalmology Glaucoma Specialist (Licence: MI 4301073621) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301073621) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2017-04-12 |