| NPI | 1548663958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2480) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100306) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2023-11-21 |