| NPI | 1417579681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301511108) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 94-10284) |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2024-07-03 |