| NPI | 1164840906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: GA 84855) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 4301105302) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: IL 036.146605) | |
| Enumeration Date | 2014-03-30 |
| Last Update Date | 2020-03-23 |