| NPI | 1184699746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00010095) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD06391) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2019-01-02 |