| NPI | 1013576644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A182560) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: UT 13258987-1205) | |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2024-03-09 |