| NPI | 1811457666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX U4612) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IL 125074574) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-11-07 |