| NPI | 1265530075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NM 290) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1166-3) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-12-05 |