| NPI | 1124387626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: OK 29985) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OK 29985) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT201060) | |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2020-07-15 |