| NPI | 1588356828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: LA 2042-988AT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO OPT.0003916) |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2024-10-09 |