| NPI | 1114981149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D66433) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD00046238) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2022-11-22 |