| NPI | 1215914478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: TX G3400) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX G3400) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2025-07-08 |