| NPI | 1316357825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME141880) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN21281) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 259173) | |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2019-09-12 |