| NPI | 1912979600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00029222) |
| Additional Taxonomies | 207WX0110X Ophthalmology Pediatric Ophthalmology and Strabismus Specialist (Licence: WA MD00029222) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2020-12-16 |