| NPI | 1306103577 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NH 24997)  | 
| Additional Taxonomies | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: IA MD-44380)  | 
| Enumeration Date | 2012-04-12 | 
| Last Update Date | 2024-10-17 |