| NPI | 1558899211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 326844) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NC 022102102) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2024-03-15 |