| NPI | 1285698753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618000624) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN OD0000002358) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2009-08-07 |