| NPI | 1063694214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00041261) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA MD00041261) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2020-10-20 |