| NPI | 1487017836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 74937-20) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 11685095-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-03 |
| Last Update Date | 2023-08-30 |