| NPI | 1164926028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: WA IMLC.MD.61517591) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 56970) |
| 207W00000X Ophthalmology (Licence: OH 35.145114) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2024-07-31 |