| NPI | 1417395245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003793A) |
| 152W00000X Optometrist (Licence: MN 3365) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2021-05-31 |