| NPI | 1730344698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT 800) |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics (Licence: MT 800) |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2023-08-29 |