| NPI | 1639480692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60503745) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301096114) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2015-06-29 |