| NPI | 1972122687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 04-49887) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2024038020) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2024-09-26 |