| NPI | 1962965863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101288650) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2026-03-13 |