| NPI | 1326109265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 3173) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE NE928) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2016-02-23 |