| NPI | 1669907911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61252434) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD204184) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2023-01-31 |