| NPI | 1851682470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist (Licence: OK 32660) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA MD.207583) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-30 |
| Last Update Date | 2021-02-04 |