| NPI | 1154588374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101252106) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A115946) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2018-12-10 |