| NPI | 1124281076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60236693) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60236693) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2021-03-30 |