| NPI | 1316040314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: LA 885189T) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA MD026103) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2009-10-07 |