| NPI | 1487585329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 156FX1100X Technician/Technologist, Ophthalmic | |
| Enumeration Date | 2026-05-28 |
| Last Update Date | 2026-06-05 |