| NPI | 1902397094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2022-00973) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R76832) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 248746) | |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2022-06-21 |