| NPI | 1366402570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NV 10317) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA C51013) |
| 207W00000X Ophthalmology (Licence: TX H4282) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2022-11-16 |