| NPI | 1801462809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 3082895-1205) |
| Additional Taxonomies | 207WX0009X Ophthalmology Glaucoma Specialist (Licence: UT 3082895-1205) |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2021-12-20 |