| NPI | 1780866111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA MD.205366) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME109326) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2014-01-09 |