| NPI | 1427496264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME157248) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD61098625) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 256109) | |
| 207W00000X Ophthalmology (Licence: TX R2271) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2022-06-08 |