| NPI | 1376505610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN MD000010678) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN MD000010678) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2016-04-04 |