| NPI | 1982415717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AZ 2369i) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: AZ 2369i) |
| Enumeration Date | 2025-01-20 |
| Last Update Date | 2025-04-04 |