| NPI | 1174781231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MS 21600) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME109594) |
| 207W00000X Ophthalmology (Licence: MS 21600) | |
| 207W00000X Ophthalmology (Licence: AL 29277) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2021-01-25 |