| NPI | 1477719755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MT MED-PHYS-LIC-25859) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD 60238854) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2013-08-01 |