| NPI | 1154587822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 2519) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 002756) |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2021-09-21 |