| NPI | 1346701950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL TRN30346) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.073631) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2021-06-02 |