| NPI | 1821597519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100631) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: ID ODP-100631) |
| Enumeration Date | 2018-02-07 |
| Last Update Date | 2024-09-14 |