| NPI | 1457581894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2017-0578) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA L-235634) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2017-07-29 |