| NPI | 1275942096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 258197) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2016-05-06 |