| NPI | 1255302287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VT 042.0012437) |
| Additional Taxonomies | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: CA 148289) |
| 207W00000X Ophthalmology (Licence: KY 49087) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2018-09-04 |