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 |