| NPI | 1255483103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1150-323) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE 1150) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2025-05-28 |