| NPI | 1790753374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: PA MD027486E) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD027486E) |
| 207W00000X Ophthalmology (Licence: NY 169815-1) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2021-04-02 |