| NPI | 1487177721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 2198) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2932) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2021-05-05 |