| NPI | 1639597354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 274392) |
| Additional Taxonomies | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: WY TL5817) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2019-07-11 |