| NPI | 1356955165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL R-325) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 2199DT) |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2022-08-19 |