| NPI | 1124314653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60738596) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: WA MD60738596) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2023-08-21 |