| NPI | 1326236738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL OPC4405) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001609) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2013-11-15 |