| NPI | 1992812234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AK MEDS3011) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD00036987) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2020-11-20 |