| NPI | 1053703819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ R80253-394382) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 29559) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R80253-394382) | |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2023-08-03 |