| NPI | 1164875787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3407) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2891) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2022-07-21 |