| NPI | 1689839086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 53925-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: UT 8236057-1205) | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2013-05-02 |