| NPI | 1205890514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: WA MD60021230) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD60021230) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2024-07-10 |