| NPI | 1780828533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 270012) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: VT 042.0013402) | |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2016-03-29 |