| NPI | 1952659203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA C186414) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WV 26997) |
| 207W00000X Ophthalmology (Licence: PA MD457911) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2023-06-14 |