| NPI | 1023270378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002459) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002051) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2010-07-07 |