| NPI | 1144649914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 53714) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.139148) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208D00000X General Practice (Licence: IN 01077499A) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2020-07-23 |