| NPI | 1508853128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61123922) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 75952) |
| 207W00000X Ophthalmology (Licence: CA C160209) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2025-03-26 |