| NPI | 1487384939 |
|---|---|
| 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: PA OEG003948) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2024-01-16 |