| NPI | 1689014409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OR MD178702) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD178702) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2020-03-02 |