| NPI | 1053936195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT 5295) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA 003241) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2024-12-05 |