| NPI | 1437247038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 1629) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN MN1629) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2022-09-02 |