| NPI | 1194989996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NV 20619) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD60284655) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2021-09-28 |