| NPI | 1639146467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00038580) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD22633) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2019-01-02 |