| NPI | 1003107400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 265873) |
| Additional Taxonomies | 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: NY 265873) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 265873) | |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2019-03-01 |