| NPI | 1548610454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 64952) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 267595) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2025-07-08 |