| NPI | 1538225917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00048106) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 31864) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2020-08-26 |