| NPI | 1538664008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2023-00775) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA 19616) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: CA 19616) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2023-08-29 |