| NPI | 1235157207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A105147) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD60022492) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-05-29 |