| NPI | 1619382405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX S5045) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A155024) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2020-04-03 |