| NPI | 1225177009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 201770) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TN 42067) |
| 207WX0009X Ophthalmology Glaucoma Specialist (Licence: LA 201770) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2017-05-31 |