| NPI | 1760678643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A46548) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA 00A465480) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2012-10-24 |