| NPI | 1760674592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00024816) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD16861) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2007-08-15 |