| NPI | 1326046426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T-02710) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1253-2) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-10-14 |