| NPI | 1730400292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery (Licence: CO DR0057538) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207W00000X Ophthalmology (Licence: IL 036133554) | |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2021-12-13 |