| NPI | 1568846467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5150) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OEG003047) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2023-05-17 |