| NPI | 1912153834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PA MD444933) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT192798) |
| 207W00000X Ophthalmology (Licence: NY 2968961) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2022-07-08 |