| NPI | 1457361560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00034861) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA 025209) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2021-12-15 |