| NPI | 1639437627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2017010591) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 0439860) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2018-10-05 |