| NPI | 1003985201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-894-TA-474) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL opc 4183) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2021-03-01 |