| NPI | 1124542345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2562) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 3399) |
| Enumeration Date | 2017-07-30 |
| Last Update Date | 2024-01-18 |