| NPI | 1912260456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 9847332-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD61522318) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2024-03-27 |