| NPI | 1750795639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-D19-TA-C40) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8384TG) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2023-03-07 |