| NPI | 1578557757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001024) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2031) |
| 152W00000X Optometrist (Licence: NC 1777) | |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2025-12-29 |