| NPI | 1659876696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CO DR.0067865) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0007170) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2022-01-26 |