| NPI | 1932197506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT001437) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ OPT-001437) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2025-03-26 |