| NPI | 1124550793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IL 036.156067) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 800281182) |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2021-07-09 |