| NPI | 1609250497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 11727694-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL38491) |
| 207W00000X Ophthalmology (Licence: MN 65283) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-12 |
| Last Update Date | 2020-07-14 |