| NPI | 1841868627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 4573) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: HI OD-1029) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2024-09-07 |