| NPI | 1235473968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 3264) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PR 696) |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2022-09-27 |