| NPI | 1437391083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 57534) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116021268) |
| 207W00000X Ophthalmology (Licence: IA R-8803) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-03-28 |
| Last Update Date | 2020-08-12 |