| NPI | 1053796730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY TP313) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY R3738) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2019-06-04 |