| NPI | 1013279298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60690632) |
| Additional Taxonomies | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: WA MD60690632) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2021-04-07 |