| NPI | 1659364917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 0430517) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2004006973) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2011-12-19 |