| NPI | 1326121336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MS 501) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 850) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2010-07-28 |