| NPI | 1124642871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002595) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 5801) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2023-08-17 |