| NPI | 1063397735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG004304) |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2025-09-02 |