| NPI | 1184614232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DC OP1000120) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PR 000337) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2009-01-07 |