| NPI | 1851813752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002189) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 2189) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2026-02-12 |