| NPI | 1427490994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NM OPT-2025-0018) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2792) |
| 152W00000X Optometrist (Licence: KY 1963DT) | |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2026-02-24 |