| NPI | 1679064075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: VA 0101281704) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 275692) |
| 207W00000X Ophthalmology (Licence: CA A177947) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: DC MD500002847) | |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: MD D0099913) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2024-08-26 |