| NPI | 1356664429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A109912) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2012-01121) |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2024-01-19 |