| NPI | 1992192884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 278639) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 264284) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2019-0044) | |
| Enumeration Date | 2015-04-19 |
| Last Update Date | 2022-02-18 |