| NPI | 1902124472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00012647) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR 8830) |
| Enumeration Date | 2010-05-08 |
| Last Update Date | 2010-05-08 |