| NPI | 1023001278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL s791 ta327) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 11485) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2012-02-27 |