| NPI | 1376722876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1620) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 607) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2011-11-15 |