| NPI | 1407801517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0009X Ophthalmology Glaucoma Specialist (Licence: LA MD.09319R) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA MD.09319R) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2020-10-06 |