| NPI | 1316084676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 063220) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD28130) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1555) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2016-03-18 |