| NPI | 1326087594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO MO2003000960) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1616) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2008-07-01 |