| NPI | 1073559274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS KS1599) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2000166654) |
| 152W00000X Optometrist (Licence: FL OPC 3482) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2009-12-08 |