| NPI | 1134276280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60745457) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2008004481) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2022-07-21 |