| NPI | 1568874907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 3359) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 073539) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2026-01-07 |