| NPI | 1538570817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX R7458) |
| Additional Taxonomies | 207WX0107X Ophthalmology Retina Specialist (Licence: ID M-15197) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2020-05-08 |