| NPI | 1861470783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A53173) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: CA A53173) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2023-04-12 |