| NPI | 1225146160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SD 685) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 02358) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2012-10-16 |