| NPI | 1902255367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A171995) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 267421) |
| 207W00000X Ophthalmology (Licence: TN 61036) | |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2025-07-10 |