| NPI | 1548416399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: FL ME118738) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME 118738) |
| 207W00000X Ophthalmology (Licence: GA 66203) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2017-12-01 |