| NPI | 1972528560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 754) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 1511) |
| 152W00000X Optometrist (Licence: NE 0754) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2023-12-25 |