| NPI | 1356725535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60636872) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008336) |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2017-05-01 |