| NPI | 1588800809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 200901546) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 242979) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2009-10-05 |