| NPI | 1205198629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301109084) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MT202104) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT202104) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2022-08-11 |