| NPI | 1023026176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 1058) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: OK 1058) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2024-12-09 |