| NPI | 1154858959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2021-01011) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.145658) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-02-29 |