| NPI | 1760010532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A190687) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: AZ 77005) | |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2026-08-27 |