| NPI | 1194777219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 0231) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NV 0231) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2011-02-02 |