| NPI | 1962562157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 12670180-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA G58650) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2022-11-14 |