| NPI | 1962898890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NM MD2019-0098) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2015-0387) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2019-10-21 |