| NPI | 1770807315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA MD.206778) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MS 22565) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2021-12-28 |