| NPI | 1437302320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD60714330) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301100132) |
| 207W00000X Ophthalmology (Licence: OR 176706) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2022-09-28 |