| NPI | 1366422545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1987) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 1984) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2023-11-17 |