| NPI | 1619991692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2003019276) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE NE1209) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2025-01-08 |