| NPI | 1497853162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00046321) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ID M9653) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-09-27 |