| NPI | 1710242490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 61822) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OK 32020) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2020-09-14 |