| NPI | 1679005219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: CA A186884) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101273499) |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2026-04-02 |