| NPI | 1912312406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SC LL38056) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R-10120) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-02-21 |