NPI | 1275532996 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD36139) |
Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD21609) |
Enumeration Date | 2005-07-14 |
Last Update Date | 2017-11-08 |