| NPI | 1316240641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60926808) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD176567) |
| Enumeration Date | 2010-12-08 |
| Last Update Date | 2021-04-29 |