| NPI | 1922536085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: UT 13786729-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 966) |
| 152W00000X Optometrist (Licence: AL T-229-TA-A71) | |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2024-02-15 |