| NPI | 1235496357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: UT 107751221205) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME127417) |
| 207W00000X Ophthalmology (Licence: UT 10775122-1205) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2023-08-16 |