| NPI | 1942432950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WY 446T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 3335ATI) |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2022-02-26 |