| NPI | 1336247816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MS 687) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MS 687P-Y) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-02-10 |