| NPI | 1881898658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A99204) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD60140026) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2015-12-22 |