| NPI | 1326454869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1424) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 074096) |
| Enumeration Date | 2014-07-04 |
| Last Update Date | 2017-05-08 |