| NPI | 1760847925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: FL ME135227) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ZZ 08RM0049782) |
| 207W00000X Ophthalmology (Licence: FL MFC1751) | |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2021-01-25 |