| NPI | 1881141562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC SC 1967) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO OPT.0003269) |
| 152W00000X Optometrist (Licence: WA OD 60701770) | |
| 152W00000X Optometrist (Licence: ID ODP - 100386) | |
| Enumeration Date | 2016-09-09 |
| Last Update Date | 2023-05-03 |