| NPI | 1003014051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-001578) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 1578) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2021-11-17 |