| NPI | 1972342368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTG00776) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618003496) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2025-07-01 |