| NPI | 1255383212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR DO22937) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA OP00002068) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2021-07-14 |