| NPI | 1629712153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA 349737) |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2026-01-07 |