| NPI | 1265887079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME152860) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 8603) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2022-01-25 |