| NPI | 1740741701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: OH 35.152718) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX U3016) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-30 |
| Last Update Date | 2025-07-29 |