| NPI | 1255626487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2021030488) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IL 036.151753) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2021-10-20 |