| NPI | 1033788351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301513481) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351047481) |
| 207W00000X Ophthalmology (Licence: MI 4351047481) | |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2025-07-25 |