| NPI | 1487656674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 0417188) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO R8108) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2008-05-18 |