| NPI | 1164869475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN 65541) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2017-00665) |
| 207W00000X Ophthalmology (Licence: GA 94783) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2024-01-18 |