| NPI | 1215925987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2001013367) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 0531000) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2019-07-08 |