| NPI | 1932418019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 2375) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NM OPT712) |
| 152W00000X Optometrist (Licence: WI 3304) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2024-06-19 |