| NPI | 1740693431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2017043011) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1818) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2025-02-24 |