| NPI | 1821403510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX S0755) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX BP10054197) |
| 207W00000X Ophthalmology (Licence: PA MD463850) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-22 |
| Last Update Date | 2020-12-23 |