| NPI | 1629171954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR OR MD17537) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA WA MD00035028) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2007-07-08 |