| NPI | 1770800138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35.123256) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD161853) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT195374) | |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2020-06-22 |