| NPI | 1033538749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101264520) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301105199) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2018-07-06 |