| NPI | 1760690804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD434338) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116016269) |
| 207W00000X Ophthalmology (Licence: MN 49519) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2008-07-02 |