| NPI | 1356752091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA MD61259007) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AR E-11308) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2024-01-03 |