| NPI | 1114128519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60074931) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A93731) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2016-02-29 |