| NPI | 1568957744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 1011) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ OPT-002262) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2023-11-13 |