| NPI | 1790757631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 04-25152) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 106616) |
| Enumeration Date | 2006-02-04 |
| Last Update Date | 2016-12-13 |