| NPI | 1659732576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35138908) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 04-44602) |
| 207W00000X Ophthalmology (Licence: KY 53669) | |
| Enumeration Date | 2016-03-20 |
| Last Update Date | 2021-06-03 |