| NPI | 1730396326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60178742) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A102954) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2020-11-04 |