| NPI | 1629081435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD20893) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD00036997) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2015-08-22 |