| NPI | 1023549169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A175685) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: OH 35.141389) | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2025-06-17 |