| NPI | 1215556469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CT 80656) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2025-05-05 |