| NPI | 1619403508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-E03-TA-B17) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC005356) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-03-11 |