| NPI | 1174744155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GU OL-046) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AK 123) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2017-06-09 |