| NPI | 1346251584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 1671) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618000561) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2009-03-11 |