| NPI | 1811280787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 9674506-1205) |
| Additional Taxonomies | 207WX0110X Ophthalmology Pediatric Ophthalmology and Strabismus Specialist (Licence: UT 9674506-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2021-10-21 |