| NPI | 1295729010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60140589) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: WA MD60140589) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2023-08-22 |