| NPI | 1306135231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 58988) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: WI 65643) | |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2016-12-08 |