| NPI | 1184636441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1672) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO T03381) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2022-08-04 |