| NPI | 1508445867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 207W00000X) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2021-04-05 |