| NPI | 1467185595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL R-364) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 3755) |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2025-08-13 |