| NPI | 1932893567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2351DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004417A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2023-08-14 |