| NPI | 1699395624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: CA A208441) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 12439653-1205) |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2026-08-13 |