| NPI | 1730181561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WY 5934A) |
| Additional Taxonomies | 156FX1100X Technician/Technologist, Ophthalmic (Licence: WY 5934A) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2019-12-19 |