| NPI | 1346647922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 009852) |
| Additional Taxonomies | 104100000X Social Worker |
| 207W00000X Ophthalmology (Licence: TN 3744) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-11-26 |
| Last Update Date | 2024-07-24 |