| NPI | 1578820759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD63933202) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD176063) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2022-02-04 |