| NPI | 1891885612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3498) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 2404ATI) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2025-04-02 |