| NPI | 1821475427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD228671) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WA MD61417092) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 8219851) | |
| Enumeration Date | 2015-05-03 |
| Last Update Date | 2026-02-06 |