| NPI | 1063788446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX q4439) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 292289-1) |
| 207W00000X Ophthalmology (Licence: IN 01081778A) | |
| 207W00000X Ophthalmology (Licence: CA A154904) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: TX Q4439) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10041058) | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2022-10-27 |