| NPI | 1487041380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: ID O-1389) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA OS020090) |
| 207W00000X Ophthalmology (Licence: ID O-1389) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2020-11-05 |