| NPI | 1972737567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A115097) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA student) |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2019-05-16 |