| NPI | 1053811620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: HI DOS-2324) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA OP60963876) |
| 208D00000X General Practice (Licence: WA OP60963876) | |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2022-12-16 |