| NPI | 1326425364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3602) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002524) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2020-03-16 |