| NPI | 1811230766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A168859) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.130547) |
| 207W00000X Ophthalmology (Licence: CT 60486) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2023-04-07 |