| NPI | 1700094109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA MD-41715) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX N6755) |
| 207W00000X Ophthalmology (Licence: KS 04-35204) | |
| 207W00000X Ophthalmology (Licence: MO 2011026868) | |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: IA MD-41715) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2018-02-15 |