NPI | 1679707541 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 068744) |
Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME114525) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116022302) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2009-05-07 |
Last Update Date | 2019-05-09 |