| NPI | 1508361189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101275161) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2022-05-19 |