| NPI | 1326030883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 2497ATI) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 2497t) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2010-07-28 |