| NPI | 1356737886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61064566) |
| Additional Taxonomies | 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: WA MD61064566) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2021-08-03 |