| NPI | 1548842693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 009549) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 3133) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-27 |
| Last Update Date | 2022-09-20 |