| NPI | 1285049940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SD 12382) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA 60841848) |
| 207W00000X Ophthalmology (Licence: CA A141899) | |
| 207W00000X Ophthalmology (Licence: WY 13306A) | |
| 207W00000X Ophthalmology (Licence: NE 33318) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0005316) | |
| Enumeration Date | 2014-06-21 |
| Last Update Date | 2021-03-15 |