| NPI | 1235224973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A48593) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A48593) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2021-01-21 |