| NPI | 1932423605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60540667) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 8995573-1205) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2015-08-27 |