| NPI | 1376513507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60165827) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ID M7313) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2014-01-17 |