| NPI | 1912433293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 66229) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 30412) |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: AZ 66229) | |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2022-06-06 |