| NPI | 1063589133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ID M3432) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD00014874) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2012-12-19 |