| NPI | 1861830119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 259281) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT204930) |
| 207W00000X Ophthalmology (Licence: NM RS2016-0703) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT204930) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2022-01-06 |