| NPI | 1821356676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO DR.0058844) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA MD457518) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2022-07-21 |