| NPI | 1205036456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: CA A107595) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A107595) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2023-05-22 |