| NPI | 1275763369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: IA MD-42656) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: MN 53448) | |
| 207W00000X Ophthalmology (Licence: WA MD60309754) | |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2016-04-29 |