| NPI | 1942658984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA OS020519) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT017140) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2020-07-13 |