| NPI | 1588869143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.095215) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 242440) |
| 207W00000X Ophthalmology (Licence: KY TP122) | |
| 207W00000X Ophthalmology (Licence: IN 01068178A) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2022-02-11 |