| NPI | 1619173986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8586) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 2068) |
| 152W00000X Optometrist (Licence: FL OPC4372) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 8586T) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2022-05-12 |