| NPI | 1861128589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL 37789) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 37789) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2023-08-29 |