| NPI | 1760826895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 50212) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY R3191) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY R3191) | |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2022-11-17 |