| NPI | 1821610189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2024-02247) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 261292) |
| Enumeration Date | 2020-05-09 |
| Last Update Date | 2024-08-14 |