| NPI | 1346624111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX T1758) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A168102) |
| Enumeration Date | 2015-07-11 |
| Last Update Date | 2022-09-13 |