| NPI | 1194411850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 3930) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 119996) |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2023-08-25 |