| NPI | 1255323648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T03319) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 1776) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2012-08-14 |