| NPI | 1518258755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 207639) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX P9617) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP20041200) | |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2018-03-17 |