| NPI | 1679223473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CO DR.0077176) |
| 207WX0009X Ophthalmology, Glaucoma Specialist (Licence: CO DR.0077176) | |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2026-05-26 |