| NPI | 1225128994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A81443) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD60929372) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2022-01-28 |