| NPI | 1952839375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61250990) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO DR.0064986) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2022-01-25 |