| NPI | 1588906465 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX S6992)  | 
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101261971)  | 
| 207W00000X Ophthalmology (Licence: DC MD044942)  | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101261971)  | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-19 | 
| Last Update Date | 2023-11-13 |