| NPI | 1407199607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: MT MED-PHYS-LIC-75060) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: CA 148143) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2020-02-12 |