| NPI | 1629651575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: CA A207161) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: FL ME174089) |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2026-05-28 |