| NPI | 1871600114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GU M-2308) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA G78322) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2022-04-25 |