| 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 |