| NPI | 1790999654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 04-33224) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2008019692) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: KS 0433224) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MO 2008019692) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2022-09-01 |