| NPI | 1881856672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301094287) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD P19869) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2009-06-30 |