| NPI | 1699110213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX T8167) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 275978) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2023-01-17 |