| NPI | 1205362993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 95595) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2024-00250) |
| 207W00000X Ophthalmology (Licence: VA 0101280997) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2024-09-12 |