| NPI | 1962513465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: CA A41624) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A41624) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2017-03-31 |