| NPI | 1235245218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD25803) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD00045209) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2014-11-06 |