| NPI | 1720221856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 73414) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2013013938) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2023-04-05 |