| NPI | 1568915213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1482) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 2025) |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2023-08-28 |