| NPI | 1770921579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 279298) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207WX0109X Ophthalmology, Neuro-ophthalmology (Licence: NY 279298) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2018-08-15 |