| NPI | 1649968009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 2197) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2023018531) |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2026-06-10 |