| NPI | 1861889776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 65545) |
| Additional Taxonomies | 207WX0109X Ophthalmology, Neuro-ophthalmology (Licence: MN 65545) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2022-07-01 |