| NPI | 1518252915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: OH 35-126075) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 35.126075) |
| 207W00000X Ophthalmology (Licence: MN 60556) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2022-03-14 |