| NPI | 1619233806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 68153) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR MD182307) |
| 208D00000X General Practice (Licence: IN 01072925A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2023-05-04 |