| NPI | 1225021843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 2553) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 02292) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2010-11-17 |