| NPI | 1033135116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0607) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP345) |
| 152W00000X Optometrist (Licence: PA OE00434ST) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2007-07-08 |