| NPI | 1487761888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA ML20008491) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA 60095538) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-09-18 |