| NPI | 1639817497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10080216) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX W4419) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2026-04-12 |