| NPI | 1205537503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101283093) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101283093) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101283093) | |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2026-03-11 |