| NPI | 1962997619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MA 292029) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: FL 26509) | |
| 207W00000X Ophthalmology (Licence: PA MT217678) | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2026-04-03 |