| NPI | 1386709277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1437-3) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO TO2946) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2007-07-08 |