| NPI | 1912018326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX M9750) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA ML20008400) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2011-02-01 |