| NPI | 1275039638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 102979) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 57744) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2025-07-29 |