| NPI | 1134126030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NE 14011) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 0420089) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2020-09-01 |