| NPI | 1871755066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA AA12070) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MT1932029) |
| Enumeration Date | 2008-06-28 |
| Last Update Date | 2016-07-12 |