| NPI | 1861758443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO DR.0059023) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME128054) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-08 |
| Last Update Date | 2021-06-11 |