| NPI | 1407502065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: 318328) |
| Additional Taxonomies | 156FX1202X Technician/Technologist, Optometric Technician |
| 156FX1100X Technician/Technologist, Ophthalmic | |
| 174H00000X Health Educator (Licence: IL 2618702) | |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2026-09-20 |