| NPI | 1356623623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX T0288) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033903) |
| 225100000X Physical Therapist (Licence: NJ 40QA01416500) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2024-04-23 |