| NPI | 1588954119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60599404) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 8437396-1205) |
| 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: WA MD60599404) | |
| Enumeration Date | 2011-04-16 |
| Last Update Date | 2020-09-07 |