| NPI | 1598929796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: ID M-12529) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO 49995) |
| 207W00000X Ophthalmology (Licence: WA MD60292777) | |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2016-12-28 |