| NPI | 1225340466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1870) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE 1343) |
| 152W00000X Optometrist (Licence: IA 002497) | |
| Enumeration Date | 2010-07-03 |
| Last Update Date | 2012-05-01 |