| NPI | 1598080558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX P6708) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2014009253) |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2021-12-22 |