| NPI | 1275845711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 002521) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 3186) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2013-12-31 |