| NPI | 1215302146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 280942) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 265300) |
| Enumeration Date | 2015-12-03 |
| Last Update Date | 2019-07-15 |