| NPI | 1528479987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AL 40751) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 51449) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: AL 40751) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2020-07-07 |