| NPI | 1144711813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207WX0110X Ophthalmology Pediatric Ophthalmology and Strabismus Specialist (Licence: PA LT000362) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2018-12-21 |