| NPI | 1689272502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 3862-35) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 3614) |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2023-11-15 |