| NPI | 1982918181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2200) |
| Additional Taxonomies | 152WX0102X Optometrist, Occupational Vision (Licence: NC 2200) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2020-11-30 |