| NPI | 1396177085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2336) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002804) |
| 152W00000X Optometrist (Licence: SC 1757) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 390250X) | |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2018-03-17 |