| NPI | 1962480780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 50142-020) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A126048) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2021-12-03 |