| NPI | 1336344282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2059) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4570) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2010-12-15 |