| NPI | 1316492598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 80245) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: AZ 80245) | |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2026-05-13 |