| NPI | 1376530071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX F4452) |
| Additional Taxonomies | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: TX F4452) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2021-03-19 |