| NPI | 1780675124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: NY 217420) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301064621) |
| 207W00000X Ophthalmology (Licence: NY 217420) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2019-01-15 |