| NPI | 1255744579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 66392) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: MT 66812) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2019-09-27 |