| NPI | 1578672135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2015030665) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD00026367) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2019-12-13 |