| NPI | 1558868851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 56659) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: TN 67449) | |
| 207W00000X Ophthalmology (Licence: GA 10766) | |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2023-05-05 |