| NPI | 1497753560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 100803) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 04-25731) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: KS 04-25731) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2019-07-08 |