| NPI | 1659343499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 0413968) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO R3904) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2012-03-29 |