| NPI | 1215007026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD0000002007) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN TN2007) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2010-03-05 |