| NPI | 1841276979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-001732) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 2340AT) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2020-05-21 |