| NPI | 1235825985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WV 3029-IOD) |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2024-05-01 |