| NPI | 1164867974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: KS 04-41989) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 04-41989) |
| 207W00000X Ophthalmology (Licence: KY 50467) | |
| 207W00000X Ophthalmology (Licence: MO 2019011729) | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2022-07-21 |