| NPI | 1659425601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D90697) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A101878) |
| 207W00000X Ophthalmology (Licence: MI 4301098254) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2021-01-07 |