| NPI | 1013301910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA MD-48564) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME139298) |
| 207WX0107X Ophthalmology Retina Specialist (Licence: IA MD-48564) | |
| 207WX0108X Ophthalmology Uveitis and Ocular Inflammatory Disease (Licence: IA MD-48564) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2021-09-16 |