| NPI | 1104356120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A186484) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101272725) |
| 208D00000X General Practice (Licence: VA 0101272725) | |
| 208D00000X General Practice (Licence: CA A186484) | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2023-07-10 |