| NPI | 1821188996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 69170) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A89430) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2021-05-11 |