| NPI | 1013946615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618000530) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618000652) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2011-07-01 |