| NPI | 1447299904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 04-35632) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2318) |
| 152W00000X Optometrist (Licence: KS 1588) | |
| 207W00000X Ophthalmology (Licence: NE 6489) | |
| 207W00000X Ophthalmology (Licence: MO 2007019126) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2012-10-15 |