| NPI | 1922490382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002257) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6421) |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2018-07-26 |