| NPI | 1194731232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 780) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 01542) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2012-04-19 |