| NPI | 1134124522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61421172) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301079868) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2024-05-07 |