| NPI | 1215033915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61305286) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: WA MD61305286) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2024-04-09 |