| NPI | 1740690924 |
|---|---|
| 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: VA 0101289286) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2026-05-06 |