| NPI | 1992100390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3252) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2821) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2023-02-12 |