| NPI | 1003909482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT-2588) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1756) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2017-03-09 |