| NPI | 1063654044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VT 042.0012718) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 53520) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207W00000X Ophthalmology (Licence: MN 105029) | |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2013-07-29 |