| NPI | 1922083690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301043660) |
| Additional Taxonomies | 207WX0009X Ophthalmology Glaucoma Specialist (Licence: MI 4301043660) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2020-08-17 |