| NPI | 1689038986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 010033) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA 10760) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2024-09-18 |