| NPI | 1790216729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OK 39138) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL HSE26122) |
| 207W00000X Ophthalmology (Licence: FL 24568) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2022-05-09 |