| NPI | 1770548265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD12291) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD00022665) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2023-03-07 |