| NPI | 1144399221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 1537) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2194) |
| 152W00000X Optometrist (Licence: IA 02245) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2011-04-08 |