| NPI | 1376093245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2493) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002527) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2022-02-16 |