| NPI | 1447294558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-001205) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ P0580A) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2026-08-14 |