NPI | 1780219394 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MA Pending) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2020-03-04 |
Last Update Date | 2020-06-24 |