| NPI | 1235575242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301111924) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R73773) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2019-08-28 |