| NPI | 1043624448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A172672) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OK 30737) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2023-05-09 |