| NPI | 1285680769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61020777) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MT 42182) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2020-09-14 |