| NPI | 1982918694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2015022433) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2010017994) |
| 207W00000X Ophthalmology (Licence: TX Q0649) | |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2021-11-16 |