| NPI | 1790075620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: MI 4301099512) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME123360) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2021-08-12 |