| NPI | 1952631632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA 127719) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT195228) |
| 207W00000X Ophthalmology (Licence: PA MT195228) | |
| 207W00000X Ophthalmology (Licence: FL TRN19262) | |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: CA A127719) | |
| Enumeration Date | 2010-01-02 |
| Last Update Date | 2020-08-07 |