| NPI | 1205806809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00044375) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 056003) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2012-01-05 |