| NPI | 1013000744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA 002274) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1489) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2014-12-05 |