| NPI | 1295231264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL R-285-TA-C02) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MS 982) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2020-09-30 |