| NPI | 1457323552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA 002316) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 956) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2022-07-21 |