| NPI | 1639481492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2014007673) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 0437115) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2018-10-08 |