| NPI | 1841351426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1782) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2002018357) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2023-10-03 |