| NPI | 1467705772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 253836) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 253836) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2020-10-27 |