| NPI | 1902691546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 5151017493) |
| Enumeration Date | 2025-04-14 |
| Last Update Date | 2025-05-04 |