| NPI | 1689025512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: CA A174238) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD470401) |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: PA MD470401) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2024-01-12 |