| NPI | 1942565890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10086196) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301100583) |
| 207P00000X Emergency Medicine (Licence: NY 277593) | |
| 207W00000X Ophthalmology (Licence: MI 4301100583) | |
| 207W00000X Ophthalmology (Licence: MO 2022006661) | |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2023-09-27 |