| NPI | 1902832926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00032819) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD000032819) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2023-01-05 |