| NPI | 1902908767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR OR MD07562) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA WA MD00027405) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2007-07-08 |