| NPI | 1356453849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S459TA282) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 0951DT) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-06-15 |