| NPI | 1811637945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A188894) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A188894) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2026-04-16 |