| NPI | 1851082242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 2221) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO MO-2024020284) |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2024-08-16 |