| NPI | 1811217912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301095046) |
| Additional Taxonomies | 207WX0009X Ophthalmology Glaucoma Specialist (Licence: MI 4301095046) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2020-08-17 |