| NPI | 1861053050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 13858841-1205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NE 8641) |
| 207W00000X Ophthalmology (Licence: OH 35.147743) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2024-11-26 |