| NPI | 1902802242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX K5936) |
| Additional Taxonomies | 207WX0009X Ophthalmology Glaucoma Specialist (Licence: TX K5936) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2017-07-10 |