| NPI | 1295514263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA SPI796) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: CA SPI796) |
| Enumeration Date | 2023-09-27 |
| Last Update Date | 2023-11-08 |