| NPI | 1194564849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 35825-TLG) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 35825-TLG) |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2024-08-13 |