| NPI | 1083665954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00046257) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR 166963) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2023-09-24 |