| NPI | 1902977655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1457) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AZ 1457) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2020-01-17 |