| NPI | 1528452463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 04-41711) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2018043038) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2025-04-18 |