| NPI | 1538748942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 85844-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 64471) |
| Enumeration Date | 2021-04-04 |
| Last Update Date | 2025-09-05 |