| NPI | 1982145819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WA OP61207451) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 1849) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-11 |
| Last Update Date | 2022-10-27 |