| NPI | 1083886857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A 107780) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IL 125049124) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125049124) | |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2021-12-15 |