| NPI | 1992770952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2852) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DE 130001291) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2025-03-13 |