| NPI | 1073748455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IL 036137996) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 254409) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP1-0037527) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: DE c7-0004306) | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2021-04-07 |