| NPI | 1700583887 |
|---|---|
| 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: NY 332603) |
| 207W00000X Ophthalmology (Licence: GA 103373) | |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2025-07-01 |