| NPI | 1730471459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NH 20397) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX r1379) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2020-12-23 |