| NPI | 1609861897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX H9216) |
| Additional Taxonomies | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: TX H9216) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2017-04-17 |