| NPI | 1477943710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61505824) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD473519) |
| 207W00000X Ophthalmology (Licence: MD D97811) | |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2024-08-01 |