| NPI | 1376546713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00048242) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA 00048242) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2024-02-13 |