| NPI | 1013255991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: CO 0066315) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116025257) |
| 207W00000X Ophthalmology (Licence: OH 34013830) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2021-09-17 |