| NPI | 1497905046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME145502) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IA R-8496) |
| 207W00000X Ophthalmology (Licence: NJ 25MA10324500) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2021-04-02 |