NPI | 1194398602 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NY 009394) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 00000) |
Enumeration Date | 2021-07-22 |
Last Update Date | 2021-09-21 |