| NPI | 1720210933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX N7685) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: MS 24706) | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2016-12-09 |