| NPI | 1013932516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MS 477) |
| Additional Taxonomies | 152WX0102X Optometrist, Occupational Vision (Licence: MS 477) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2012-03-15 |