| NPI | 1235703067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10075595) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO 0074801) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2025-07-02 |