| NPI | 1396741005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60818145) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA G40056) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2024-01-03 |