| NPI | 1881135093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3573) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: MN MN3573) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2021-11-16 |