| NPI | 1275910697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 098907) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT CT2952) |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2020-08-11 |