| NPI | 1861184830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SD 815) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046011757) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2024-09-08 |