| NPI | 1720841182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: CA A193139) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A193139) |
| Enumeration Date | 2024-01-30 |
| Last Update Date | 2024-07-01 |