| NPI | 1336229855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2791) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 1530) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2011-12-22 |