| NPI | 1699748020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD159840) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ID M13975) |
| 207W00000X Ophthalmology (Licence: WA MD60801522) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2022-07-18 |