| NPI | 1447870258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1533) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 099902) |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2021-09-27 |