| NPI | 1144750399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IL 036.156668) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301112708) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2021-06-17 |