| NPI | 1255758199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AL 38112) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 079762) |
| 207W00000X Ophthalmology (Licence: MS 27236) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2021-03-09 |