| NPI | 1457898595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101265526) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 30983) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2024-08-20 |