| NPI | 1366891434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ME OPT990) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH OPT 6465) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2022-07-21 |