| NPI | 1073121307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4351053059) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX S437631) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2025-07-15 |