| NPI | 1720379100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: CA A123812) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: DC MD042959) | |
| 207W00000X Ophthalmology (Licence: VA 0101257811) | |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2020-06-24 |