| NPI | 1841857562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 10155T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL T-238-TA-B44) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2023-01-10 |