| NPI | 1225457534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 73725-20) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MS 23942) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2023-04-24 |