| NPI | 1194885848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002416) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA1885) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2008-01-18 |