| NPI | 1225007453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: PR 12791) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2008-03-12 |