| NPI | 1215930557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT 534 OPT) |
| Additional Taxonomies | 152WX0102X Optometrist, Occupational Vision (Licence: MT 534 OPT) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2014-10-24 |