| NPI | 1801637244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 2254) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 3277) |
| 152W00000X Optometrist (Licence: MO 2025000170) | |
| Enumeration Date | 2024-05-31 |
| Last Update Date | 2025-07-28 |