| NPI | 1245645258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2020037894) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-08400) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2022-09-12 |