| NPI | 1730476730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OK 29168) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: OK 29168) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11016020A) | |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2020-04-21 |