| NPI | 1164497558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00039695) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD20654) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2023-03-07 |