| NPI | 1093342107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX U8723) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX BP10074518) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2024-04-12 |