| NPI | 1922366459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine (Licence: TN 59609) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME128219) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2023-08-28 |