| NPI | 1518950880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 0421567) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO MDR5E42) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2011-12-20 |