| NPI | 1659163111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002985) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID 6171668) |
| Enumeration Date | 2025-05-20 |
| Last Update Date | 2026-08-24 |