| NPI | 1962935122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 274683) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2020-1166) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2021-01-02 |