| NPI | 1558599217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NM 690) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 2417) |
| 152W00000X Optometrist (Licence: AL S-C24-TA-843) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2020-04-06 |