| NPI | 1043699259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 322816) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND RL13750) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2020-06-24 |