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 |