| NPI | 1568705788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME140160) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY TP739) |
| 207W00000X Ophthalmology (Licence: IA R-09930) | |
| 207W00000X Ophthalmology (Licence: OH 35131152) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-06 |
| Last Update Date | 2019-08-06 |