| NPI | 1013925791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2692) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2498) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2012-02-08 |