| NPI | 1669407086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD0028072) |
| Additional Taxonomies | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: WA MD00028072) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2017-09-15 |