| NPI | 1568733681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA C175920) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101254527) |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2024-02-18 |