| NPI | 1194969543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PR 18467) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: PR 27744-R) | |
| 207W00000X Ophthalmology (Licence: PR 27848R) | |
| 207W00000X Ophthalmology (Licence: GA 69367) | |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2014-08-18 |