| NPI | 1538427455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 283648-1) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 261QS0132X Clinic/Center, Ophthalmologic Surgery | |
| Enumeration Date | 2012-04-28 |
| Last Update Date | 2016-07-21 |