| NPI | 1831547900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 2038) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2016020857) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2020-07-13 |