| NPI | 1417919648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL 3A90TA658) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL S-A90-TA-658) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2023-01-26 |