| NPI | 1639449721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MD D84883) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: DC MD045933) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101264466) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: DC MD45933) | |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2019-11-06 |