| NPI | 1649699307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX S4118) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 65349) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10050031) | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2020-07-14 |