| NPI | 1326498593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IA 47090) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IL 036152654) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL 0006167) | |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2020-10-12 |