| NPI | 1003149113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2174) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: HI 703) |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2016-03-10 |