| NPI | 1871870337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: DE C20011223) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DE FM5146281) |
| 207W00000X Ophthalmology (Licence: DE DR0010708) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.004219) | |
| Enumeration Date | 2011-11-12 |
| Last Update Date | 2022-09-01 |