| NPI | 1386719953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AK OPTT161) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AK 161) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2018-05-16 |