| NPI | 1063420974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A40547) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A40547) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2021-11-10 |