| NPI | 1356961213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3649) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 2642) |
| 152W00000X Optometrist (Licence: OK 3079) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2023-09-21 |