| NPI | 1700841046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G56891) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NV 18490) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2024-12-19 |