| NPI | 1962649657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MS 829) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 152W00000X Optometrist (Licence: TN 2895) | |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2015-01-05 |