| NPI | 1134462161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GU M-2201) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2016-0346) | |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2020-08-11 |