| NPI | 1205367943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KS 0447319) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MO 2023008558) |
| 207W00000X Ophthalmology (Licence: CA A158827) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2023-10-20 |