| NPI | 1669600649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DC DO034868) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CT 051653) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2019-12-20 |