| NPI | 1528682796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD485090) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT221018) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM MT221018) | |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2024-06-21 |