| NPI | 1245246107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-B49TA-200) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL T73-TA-200) |
| 152W00000X Optometrist (Licence: MA 4903) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2013-05-28 |