| NPI | 1972037018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL OS17574) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS17574) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-15 |
| Last Update Date | 2022-09-16 |