| NPI | 1275859399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60151712) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 32843-020) |
| 207W00000X Ophthalmology (Licence: OR MD150509) | |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2019-07-12 |