| NPI | 1639564446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MN 69362) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 266351) |
| 207W00000X Ophthalmology (Licence: MN 69362) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2018-0944) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2023-04-26 |