| NPI | 1689604688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 22706) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO R3G29) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2012-09-14 |