| NPI | 1598148892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV008292) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY TUV008292-1) |
| Enumeration Date | 2015-07-04 |
| Last Update Date | 2016-08-02 |