| NPI | 1801355995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 61426806) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 00882) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2025-01-22 |