| NPI | 1508992108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G132141) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TN 25861) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2014-10-14 |