| NPI | 1194258624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301508400) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 328103) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2025-08-05 |