| NPI | 1730553736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2444) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1907) |
| Enumeration Date | 2015-11-15 |
| Last Update Date | 2024-02-05 |