| NPI | 1639670912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NV 22654) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101268976) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2023-08-09 |