| NPI | 1073034898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-D84-TA-A78) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 1125) |
| Enumeration Date | 2017-07-01 |
| Last Update Date | 2022-05-18 |