| NPI | 1720423577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2019039153) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 04-39977) |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2020-05-27 |