| NPI | 1649393679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: VA 0101241345) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101241345) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2017-09-07 |