| NPI | 1619316395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 60860) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME131460) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2020-02-10 |