| NPI | 1679775571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301097817) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A109725) |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2021-12-03 |