| NPI | 1437107406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 348457) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 75279) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 152W00000X Optometrist (Licence: TX 6830 TG) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2025-09-11 |