| NPI | 1487157269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A180519) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2021-0241) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT218680) | |
| Enumeration Date | 2018-03-17 |
| Last Update Date | 2022-09-13 |