| NPI | 1801203088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA OP60973150) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR DO185372) |
| Enumeration Date | 2014-07-19 |
| Last Update Date | 2024-01-03 |