| NPI | 1780023960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 91060) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101257297) |
| 208D00000X General Practice (Licence: VA 0101257297) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2022-08-10 |