| NPI | 1073752150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00030974) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA G13257) |
| Enumeration Date | 2009-02-12 |
| Last Update Date | 2009-02-12 |