| NPI | 1043507205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: WA MD60704061) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 58899) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2023-02-08 |