| NPI | 1386873180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL R-251-TA-A69) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MS 944TPA94515) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2019-05-22 |