| NPI | 1821354895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 201901061) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301109100) |
| 207W00000X Ophthalmology (Licence: TN MD0000055628) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2022-09-22 |