| NPI | 1326663071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002870) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 3149) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2025-07-25 |