| NPI | 1356720395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME150234) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: SD 18432) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2026-04-30 |