| NPI | 1578880902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD 60446483) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 101273408) |
| 207W00000X Ophthalmology (Licence: VA 0101273408) | |
| Enumeration Date | 2010-04-25 |
| Last Update Date | 2021-12-01 |