| NPI | 1518930858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61006266) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101052897) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2022-02-16 |