| NPI | 1629531116 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207WX0120X Ophthalmology, Cornea and External Diseases Specialist (Licence: OR DO220449) | 
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OR DO220449) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-11 | 
| Last Update Date | 2025-07-08 |