| NPI | 1023007416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 232) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WY 179T) |
| 152W00000X Optometrist (Licence: CA 8563) | |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2012-08-01 |