| NPI | 1467787226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 57762) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: NC 2013-00778) | |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2014-06-13 |