| NPI | 1801359393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CT 78979) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 260919) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: CA Pending) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2024-12-03 |