| NPI | 1154996437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX BP10075604) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10075604) |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2022-04-11 |