| NPI | 1942377502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD00030634) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: ID M-11172) |
| 207W00000X Ophthalmology (Licence: AK MEDS7014) | |
| 207W00000X Ophthalmology (Licence: MT MED-PHYS-LIC-12529) | |
| 207W00000X Ophthalmology (Licence: OR MD151666) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-11-19 |