| NPI | 1225391725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A146756) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD457613) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2018-03-17 |