| NPI | 1972667384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1303) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 948) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2018-01-18 |