| NPI | 1851965198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 303038) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 2025-00073) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2025-01-20 |