| NPI | 1477788412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A115035) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD60333195) |
| 207W00000X Ophthalmology (Licence: SD 9580) | |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2021-11-22 |