| NPI | 1184816696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 54774-020) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 20007) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2018-06-16 |