| NPI | 1609175959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IL 036.138392) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: IL bf4649604-a 781) | |
| 207W00000X Ophthalmology (Licence: IA 9339) | |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2015-08-05 |