| NPI | 1679830772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: OR MD1841) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A131188) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2022-07-21 |