| NPI | 1922668102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 1054) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 34275TLG) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2020-10-06 |