| NPI | 1598717860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00030114) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD 13791) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2018-03-17 |