| NPI | 1114938990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA 30698) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ID M-6605) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2021-12-15 |