| NPI | 1598127243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 04-46569) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2022028016) |
| 207W00000X Ophthalmology (Licence: OH 35138864) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: KS 04-46569) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MO 2022028016) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-09-06 |