| NPI | 1942374111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD35675) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00035675) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2013-10-31 |