| NPI | 1225167919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD27236) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A85913) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2021-11-01 |