| NPI | 1235180696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60771806) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD428632) |
| 207W00000X Ophthalmology (Licence: AZ 37045) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2021-02-16 |