| NPI | 1811387061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TN 71361) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 276423) |
| 207R00000X Internal Medicine (Licence: MA 276423) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2025-11-04 |