| NPI | 1003120262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME120238) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX N7218) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2020-06-01 |