| 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 |