| NPI | 1285293233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 1014091) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: RI LP04910) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2024-02-01 |