| NPI | 1336297704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ME ME Opt 883) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA GA 1778) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2012-09-05 |