| NPI | 1063512101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD24417) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD00045917) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2012-07-27 |