| NPI | 1457548455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2011-00008) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT190230) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2022-10-28 |