| NPI | 1972823763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 25MA10052400) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX P6404) |
| 207WX0107X Ophthalmology, Retina Specialist (Licence: NJ 25MA10052400) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2022-03-10 |