| NPI | 1245557487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 0852) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 503) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2010-04-28 |