| NPI | 1649890930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2819) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 3060) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2022-05-13 |