| NPI | 1194005850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-C77-TA-921) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC004618) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2012-06-04 |