| NPI | 1326295502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 83633) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD60627739) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: GA 83633) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2019-07-08 |