| NPI | 1063855534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101266721) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT203488) |
| 207W00000X Ophthalmology (Licence: MD D0088041) | |
| 207W00000X Ophthalmology (Licence: VA 0101266721) | |
| 207W00000X Ophthalmology (Licence: DC MD047105) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: DC MD047105) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MD D0088041) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2019-11-05 |