| NPI | 1073008314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1530) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 091798) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2021-05-19 |