| NPI | 1013570381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD61048791) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV009000-01) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2020-08-06 |