| NPI | 1417006057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DC OP532) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DE I3-0001265) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2022-02-17 |