| NPI | 1982107702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 71637) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301506610) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-18 |
| Last Update Date | 2024-05-20 |