| NPI | 1164953295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IL 036.155828) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 670986869) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2023-09-21 |