| NPI | 1497105811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD205372) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: UT 11685097-1205) |
| 207W00000X Ophthalmology (Licence: OK 32820) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11018880A) | |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2021-11-17 |