| NPI | 1528043023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: CA A82894) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A82894) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2017-04-03 |