| NPI | 1821327883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 60750) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A110007) |
| 207W00000X Ophthalmology (Licence: UT 8179888-1205) | |
| Enumeration Date | 2009-12-21 |
| Last Update Date | 2016-09-01 |