| NPI | 1952375792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 050431) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD00045759) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2020-08-03 |