| NPI | 1467617159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA 20A9417) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A9417) |
| 208D00000X General Practice (Licence: CA 20A9417) | |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2022-05-18 |