| NPI | 1073661724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 1972) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0601000923) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-09 |