| NPI | 1144472903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD197672) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA RC60024519) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2020-06-24 |