| NPI | 1619901238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA MD02900R) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A21991) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-02-04 |