| NPI | 1346429503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC SC551) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC NC0941) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2007-11-30 |