| NPI | 1629496849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2018012250) |
| Additional Taxonomies | 207WX0107X Ophthalmology, Retina Specialist (Licence: MO 2018012250) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2018-09-12 |