| NPI | 1194214890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 2241) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MT OPT-OPT-LIC-3095) |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2022-01-19 |