| NPI | 1558940254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A181703) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GU TLL-2025-002) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2025-08-06 |