| NPI | 1508109133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: CA A134110) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD460411) |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2019-08-12 |