| NPI | 1730634908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A195736) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IL 125.076718) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2024-09-06 |