| NPI | 1598740631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 1734) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1102) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2022-05-04 |