| NPI | 1114366440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: MI 4301502124) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A135081) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2021-02-09 |