| NPI | 1093202004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX T5261) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 39020000) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2022-04-25 |