| NPI | 1336147784 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: CT 032433) | 
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CT 032433) | 
| Enumeration Date | 2005-07-11 | 
| Last Update Date | 2021-02-09 |