| NPI | 1114284825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 266012) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: NM RS2015-0471) | |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2016-09-06 |