| NPI | 1730281247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1566) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 200161249) |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2022-11-09 |