| NPI | 1205205457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002590) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008335) |
| 152W00000X Optometrist (Licence: NJ 27OA00662900) | |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2023-11-15 |