| NPI | 1295066918 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 258433) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX P5723) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2025-02-14 |