| NPI | 1497429815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3788) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 009435) |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2024-10-25 |