| NPI | 1538654470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID 100653) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ OPT-002255) |
| Enumeration Date | 2018-06-23 |
| Last Update Date | 2024-07-12 |