| NPI | 1437121928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL R-196TA-881) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 1170) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2019-12-19 |