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 |