| NPI | 1316272032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AK A-131) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID O-548) |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2013-08-07 |