| NPI | 1033406780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: CA A146139) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301099094) |
| 207W00000X Ophthalmology (Licence: MA 262169) | |
| 207W00000X Ophthalmology (Licence: CA A146139) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2022-07-21 |