NPI | 1437107406 |
---|---|
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: TX 6830 TG) |
207Q00000X Family Medicine (Licence: MN 75279) | |
Enumeration Date | 2006-05-04 |
Last Update Date | 2023-09-11 |