| NPI | 1073223277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1584) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 10797T) |
| Enumeration Date | 2022-11-29 |
| Last Update Date | 2025-05-07 |