| NPI | 1205233848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 101583) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 61126698) |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2025-06-03 |