| NPI | 1699394874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A206386) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SD 15525) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2025-12-16 |