| NPI | 1083724900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301089275) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 0433684) |
| 207W00000X Ophthalmology (Licence: WA MD00045533) | |
| 207W00000X Ophthalmology (Licence: MO 2009008676) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-02-09 |