| NPI | 1427658921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002774) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: KY 2209DT) |
| 152WS0006X Optometrist, Sports Vision (Licence: KY 2209DT) | |
| 152W00000X Optometrist (Licence: KY 2209DT) | |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2024-04-04 |