| NPI | 1790730158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1567) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 2011) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2023-04-03 |