| NPI | 1326452673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2020032247) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME135239) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-15 |
| Last Update Date | 2020-11-05 |